WORKING WITH ETHNICITY, RACE AND CULTURE IN MENTAL HEALTH doc

WORKING
WITH
ETHNICITY, RACE
AND CULTURE
IN MENTAL HEALTH
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Working
with
Ethnicity, Race
and Culture
in Mental Health
A Handbook for Practitioners
Hári Sewell
Jessica Kingsley Publishers
London and Philadelphia
First published in 2009
by Jessica Kingsley Publishers
116 Pentonville Road
London N1 9JB, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.jkp.com
Copyright Ó Hári Sewell 2009
For further information please visit www.harisewell.com
All rights reserved. No part of this publication may be reproduced in any
material form (including photocopying or storing it in any medium by
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other use of this publication) without the written permission of the
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Library of Congress Cataloging in Publication Data
A CIP catalog record for this book is available from the Library of Congress
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 978 1 84310 621 0
ISBN pdf eBook 978 1 84642 855 5
Printed and bound in Great Britain by
Athenaeum Press, Gateshead, Tyne and Wear
To Jacqui Dillon, my Rock. My constant. Thank you for creating so much
from so little.
To my precious and absolutely stunning sons James-Earl and Aaron.
Thank you for giving me so much love and support to get to the end of this
project.
Dara and Sia. Thank you for the affection and the space.
Lorenzo and Hazel Sewell. You are the explanation most people seek
from me.
Acknowledgements
Thanks to my colleagues who have rehearsed these ideas with me for 15
years. Your influences are reflected here: Errol Francis, Sue Holland, Suman
Fernando, Yvonne Christie, Melba Wilson, Sharon Jennings, Sandra
Griffiths, Malcolm Phillips, Frank Keating, Parimala Moodley, Lennox

Thomas, Olivia Nuamah, Kwame McKenzie, Barbara D’Gamma.
To those who were critical in setting high standards: Martin Smith, Jo
Cleary.
And to Francesca Russo, Peter Gilbert, James Sandham and Geoff
Alltimes.
Contents
Foreword by Dr Suman Fernando 11
1. What is ‘Ethnicity, Race and Culture’? 13
Definitions 13
Race 14
Ethnicity 17
Culture 19
The problem with race 21
Institutional racism 22
Nomenclature – black and minority ethnic groups 25
Conclusion 25
2. Why are Ethnicity, Race and Culture Important
in Mental Health Services? 26
Legislation and policy 26
The implications of variations: Ethnicity, race and culture
in mental health 29
Hypotheses about causes of variations 31
Toxic Interactions Theory – a new perspective 34
Relationships between areas of variation 37
Taking ethnicity, race and culture into account as a practitioner 39
Conclusion 43
3. Quality Assessments 44
Components of an assessment 45
Ethnicity, race and culture and the assessment process 46
Racism Diagnostic and Review Tool (RaDAR Tool) 52

Conclusion 55
4. Recovery-focused Care Planning 56
Definition 56
Conflicts with the recovery-focused approach 57
Implementing recovery-focused care planning 57
Conclusion 69
5. Quality Relationships in the Delivery of
Care Plans 72
Rationale for focusing on the relationship 74
Trust 76
Obstacles to effective relationships 77
Speaking about race and racism 82
Conclusion 88
6. Ethnicity in the Context of Other Identities 89
Sexuality 89
Mixed heritage 96
BME children brought up in white families or in public care 101
Gender 104
Disability 112
Making complexity manageable 114
Conclusion 123
7. The Role of the Team Manager 124
Business and performance management of the team 124
Management of individual team members 130
The role of the manager as an advocate 143
Conclusion 144
8. The Role of the Training, Education, Learning
and Development Department 145
Developing competence 145
Informing organisational strategy 147

Developing the knowledge and skills of the workforce:
Getting from A to B 148
Defining competence 150
Responding to gaps: The content of education, learning
and development 153
Getting from A to B: Applying the different approaches 157
Conclusion 157
9. Considering Alternatives to the
Illness Model 159
Psychiatry and race 161
Faith and religion 162
Hearing Voices Approach 164
Trauma approaches 165
Recovery Approach 169
Explanatory models 170
Alternative models and the impact on practice 170
Conclusion 171
10. Positive Examples of Doing it Differently 172
Exploring examples of positive practice 174
Conclusion 181
11. Conclusion 182
References 184
Subject Index 196
Author Index 206
Tables
1.1 Race, ethnicity and culture 13
1.2 Language of discrimination 22
2.1 Utilisation of different services 38
3.1 Critical analysis of referrals for black people 48
3.2 Critical analysis of referrals for Asian and other

minority ethnic groups 51
4.1 Template: Working towards recovery with service users 70
6.1 Sewell’s Seven Elements for Strengthening Practice 116
7.1 Evaluation of team performance 127
7.2 Template: Identifying and Responding to views of
minority groups 129
8.1 ERC competencies 151
8.2 Template: Matching development methods to competencies 158
Figures
1.1 Institutional racism 23
5.1 The 4 Ps in the therapeutic relationship 73
5.2 Relationship as the container for change in the 4 Ps 74

Foreword
The past few years have seen many books commenting on the failure of
mental health services to meet the needs of black and minority ethnic
people. Some highlight the effects of racism – especially ‘institutional
racism’ – while others emphasise the lack of sensitivity to cultural difference
in the ways of working, especially the ‘medical model’ of (Western) psychia-
try on which services are generally based. Government plans to address the
problems top-down appear to try riding both horses, but all too often fall
between them or fall off both.
What is happening at the coal face of mental health care is that profes-
sionals are left searching for ways forward, trying to meet the proper and
just expectations of culturally diverse service users, trying not to be racist in
practice, and endeavouring to improve the quality of service that they
provide. Going back to school, studying the faults in the systems they are
supposed to work with, analysing their own capabilities, undergoing
training to become ‘culturally competent’ (whatever that means) and so on,
are not really options for most busy people under pressure. They have to

make do, learn a bit about issues to do with race, ethnicity and culture, how
an ideal system should work and try to understand how their own practices
can contribute to ensuring that the service is improved for everyone. This is
where this book by Hári Sewell comes in. This is a book for practitioners –
essentially a self-training book but also one that could be used as a source of
knowledge in a complex and controversial field.
The author knows about the realities at the grass roots, how NHS
mental health care is currently set up, what types of approach are practicable
and what are not and he understands what busy practitioners may look for
in a book called a ‘handbook’. What he has done is to digest the literature,
think about matters, connect with service users, talk with managers and pro-
fessionals and then provide readers with a succinct account geared towards
helping practitioners to change their practice – indicating how and why
these changes can make a real difference.
This book discusses all the main aspects of terms used in the field of
mental health care in relation to a culturally and racially diverse population.
It then delves into practical matters – assessments, recovery focused care and
11
so on, providing clear practical guidance on implementation, illustrated by
concrete examples from real life and many case descriptions. Most impor-
tantly the book provides evidence and a rationale for every suggestion that
is made, indicating the author’s wide ranging knowledge and grasp of the
topics discussed. The tables and illustrations help to focus effectively on the
main aspects of what the author is trying to convey. This is a book directed
to people working at ground level in mental health services where the
action takes place – a very practical book informed by common sense, a
wealth of knowledge and clear thinking.
Dr Suman Fernando,
European Centre for Migration and Social Care (MASC),
University of Kent.

12 / WORKING WITH ETHNICITY, RACE AND CULTURE IN MENTAL HEALTH
13
Chapter 1
What is ‘Ethnicity,
Race and Cult ure’?
Language conveys many things; some intended and others not. An attempt
to achieve precision in the use of terms specific to any area of study can be
viewed as pedantic or futile. Terminology develops as a means to establish a
shared understanding but people intend or hear different meanings. This
chapter sets out definitions of ethnicity, race and culture (ERC). The aim is
to establish a common understanding between author and reader about the
intended meanings for terms used in this book.
A lack of precision in understanding terms and concepts leads to confu-
sion and poorer response to need. For example, a focus on culture in a
context where race (and racism) is the issue, fails to address the real problem
appropriately.
Fernando (1991) provides a succinct description of the diff erence between
ethnicity race and culture. His helpful chart is reproduced in Table 1.1:
Table 1.1 Race, ethnicity and culture
Characterised by Determined by Perceived as
Race Physical
appearance
Genetic ancestry Permanent
(genetic /
biological)
Culture Behaviour
Attitudes
Upbringing
Choice
Changeable

(assimilation,
acculturation)
Ethnicity Sense of
belonging
Group identity
Social pressures
Psychological need
Partially
changeable
(Fernando 1991, p.11)
Cashmore and Troyna (1990) provide a useful glossary including defini-
tions of less frequently used terms such as colonialism and social Darwin-
ism. Many contemporary writers in the field of mental health provide
helpful insights into the distinction between terms (e.g. Bhugra and Bhui
2002; Moodley and Palmer 2006).
Race is the most fundamental of the terms to be considered because of the
historical backdrop of systematic forms of racial oppression, for example
slavery. Race was considered to be fixed through biology, however as
science progressed it has become clear that the old assumptions about race
were inaccurate. Arguments have been made since the early 20th century
that the biological basis for the division of humans into races is flawed
(Banton 1967). Rack (1982) sets out persuasive arguments for dismantling
the concept that races are well-defined groups of people who are biologi-
cally and genetically alike. The genetic differences within so-called racial
groups are sometimes greater than those between people of different races.
There is no complete set of genetic characteristics that defines a race (Senior
and Bhopal 1994). Therefore the use of race as a reliable biogenetic divide is
flawed. Race cannot reliably be used to provide a genetic explanation for
trends and patterns (Bhopal 1997). The main benefits of applying the
concept of race are social (Banton 1967).

The distinction being made here is that science is based on the pursuit
of reliability and certainty. The genetic concept of race cannot provide this;
in the social world, however, interactions between people based on assump-
tions about race serve the purpose of stratifying global and national popula-
tions (Altman 2006; Banton 1965). It serves societies well to continue to
promote the concept of race and to accentuate difference as it creates a social
order.
Many social and economic concerns about disparities associated with
race could potentially be tackled by considering class as the salient charac-
teristic (Alexander 1987). This would perhaps be more honest as it would
apply social analysis to social ills as opposed to the use of a term that implies
a scientific coherence where there is none. People are attacked and killed
because of their perceived race so though class does provide a paradigm it
does not hold all the answers.
This discussion is clearly not a theoretical argument about whether or
not race exists. It is absolutely apparent in injustices of everyday life and in
the more extreme cases of murder, that race does exist. It is important,
however, that people in mental health services understand that the patterns
and trends that seem to relate to race are at best seen as a negative conse-
14 / WORKING WITH ETHNICITY, RACE AND CULTURE IN MENTAL HEALTH
quence of how people are initially perceived. Searches for biological expla-
nations have failed (McKenzie and Chakroborty 2003). Of the three terms
being explored here (ERC), race is the one that is considered to be within
the person and fixed (see Table 1.1). In practice it is utilised as a signifier for
ethnicity and/or culture and, erroneously, for class (Williams 1997).
Race is important because it affects how people are perceived, including the
ascribing of a range of stereotypes. The ascribing stereotypes based on race
is not something that is only done by white people. People within minority
groups often hold negative stereotypes about their own ethnic group and
will have a split created within themselves where they seek to have a positive

sense of self whilst seeing their ethnicity as representative of negative
attributes. Fanon (1967) describes very well the internalisation of the
negative stereotypes. People of different backgrounds will perceive race as
having some meaning because in essence race is shorthand, a cipher, for
other assumptions ascribed through national and global socialisation
processes.
Racism, that is discrimination on the basis of race (rather than ethnicity
or culture), is an emotive subject as was evident around the launch of the
government’s response to the Blof eld report of the investigation into the
care and treatment of David ‘Rocky’ Bennett (NSCSTHA 2003).Govern-
ment ministers were asked by the inquiry panel and some leaders in the field
of race and mental health to accept the finding of the panel that the
WHAT IS ‘ETHNICITY, RACE AND CULTURE’? / 15
Box 1.1 Illustration
A black man in his mid-twenties is being assessed.He appears to be
black African or African Caribbean. His ancestry is in fact part
South American and part Caribbean. He was brought up in an
upper-middle-class environment in Ecuador, has a university
degree and has a strong South American identity.When assessed in
the English mental health services for the first time the social
worker considers race as part of the process.The physical appear-
ance of this man, i.e. that he is black, offers no reliable or useful
information other than the knowledge that he is probably per-
ceived as having particular experiences and attributes because he
looks black.It is the relationship between his blackness and society
that creates meaning. His ethnic identity will in its own right bring
richer information, which will include his ‘race’ as well as culture,
geographical heritage, language and religion.
National Health Service (NHS) was institutionally racist. This position was
never adopted by the government though senior officials in the Department

of Health had said, in response to the inquiry panel’s questioning, that the
NHS was institutionally racist. Ministers stated that discrimination was
present in the NHS but refused to use the term ‘institutionally racist’
(Guardian 2005). This illustration highlights the sensitivity around race
being the focus of discrimination.
Government audits and research findings highlight that the poorest
experiences and outcomes of black and minority ethnic (BME) groups in
mental health services relate to people from African and African Caribbean
backgrounds (the African Diaspora) (Commission for Healthcare Audit and
Inspection 2007a). This broad sweep of people with heritages in the second
largest continent and a raft of islands are united singularly in the fact that
they are perceived as belonging to the same race (rather than ethnic or
cultural group). It stands to reason that if it can be accepted that discrimina-
tion occurs (which the government did) and that this consistently has a par-
ticular impact on people who are considered as belonging to a single race,
the specific type of discrimination is racial discrimination.
The reluctance to accept a charge of racism may reflect a decoupling of
closely related concepts. Bhugra and Bhui (2002) point out that racism, as
opposed to racial discrimination, is more rooted in the ideological belief in
the inferiority of races. Though racial discrimination may not be driven by
individuals who consciously hold these beliefs, institutional racism is the
consequence of the individual’s unwitting acts (see Figure 1.1 later in this
chapter).
Each decade sees a massive upturn in international travel, interracial rela-
tionships and the erosion of the notion of three distinct races, however,
Post-Darwinian classifications of the races into black, Asian and white have
remained current (Cashmore and Troyna 1990). Banton (1967) conducted
a study of the history of racial categorisations of humans, beginning with
the work of Aristotle. His conclusions were that a primary function of race is
to create social stratification manifested as racism, with the power of white

people over all others creating the clearest divide. In an echo of his study
Okitikpi (2005a) argues that racially the world is considered to be binary;
people are either white or they are not! In Western societies and in urban
areas in particular, however, there are many variations to perceived races and
ethnicities. This means that old classifications are too narrow to capture the
true heritage of people in mental health services (Hall 1996).
16 / WORKING WITH ETHNICITY, RACE AND CULTURE IN MENTAL HEALTH
In mental health provision a failure to acknowledge the unique experi-
ences of people from mixed heritage weakens assessments and limits the
analysis of problems. The need to consider mixed heritage in its own right is
discussed in Chapter 6. In the illustration in Box 1.1 the man considered to
be black was in fact of mixed heritage. Based on physical characteristics
alone assumptions can easily be made and attributes ascribed erroneously.
In summary, the physical characteristics of race tell us little more than
the fact that someone is likely to have experienced discrimination on the
basis of this attribute.
Ethnicity encapsulates a range of factors used to identify individuals and
may relate to language, geographical origin, skin colour, religion and
cultural practices. As such, ethnicity is not a fixed or easily definable
concept. Stuart Hall (1996) argues that in multicultural Britain new ethnici-
ties are being developed. Ethnicity therefore can be fluid and is based
largely on self-definition. As such, the term is not easily subjected to inflexi-
ble definitions (Senior and Bhopal 1994). For a practitioner, the ethnicity of
service users is a gateway to issues that they consider to be relevant to their
identity: who they are, how they live and their relationship with services.
The term ‘ethnicity’ has its roots in a Greek word for people or tribe
(Senior and Bhopal 1994). Ethnic group and ethnic origin have been
defined differently. Ethnic origin is fixed and pertains to religion, language,
geography, physical appearance and the culture associated with these
factors. Ethnic group is self-defined though is usually related to the afore-

mentioned characteristics (Bhopal 1997; Department of Health 2005a).
Self-definition means that the potential richness of information cannot
be inferred but must come from further exploration with the service user.
Ethnicity is not neutral. Modood et al. (1998) highlight the various and
extensive aspects of life in which minority ethnic groups experience disad-
vantage. Hall (1996) discusses the loaded notion of ‘difference’ and the fact
that ideas about race and ethnicity are yet to be decoupled. Further to the
actual disadvantage experienced by people from BME backgrounds, an
association is created with negative f actors, as is the case for race. In seeking
to break these associations, Williams (1997) states that ‘race is not a cipher
for…poverty…disease…bestiality…the subhuman…exotic entertain-
ment’ (pp.60–61).
The term ‘minority ethnic group’ most reliably conveys disadvantage
and, often, inferiority (Bhopal 1997). These inferences affect people
whether they are from within or outside a minority ethnic group.
WHAT IS ‘ETHNICITY, RACE AND CULTURE’? / 17
‘Minority ethnic groups’ is a term developed around the 1980s follow-
ing on from its inaccurate predecessor ‘ethnic minority groups’. The
problem with this earlier term is that it implies that ‘minority groups’ are
ethnic; the assumption being that only ‘different’ people have an ethnic
identity. In Western societies this would equate to white people being eth-
nicity-free. This is clearly not the case. All people have an ethnic identity.
The current description makes it clear that those being referred to are ethnic
groups that together or singularly are in the minority in a society. In some
societies, such as on the African continent, white communities are in the
minority. It is striking, however, that the term ‘minority ethnic group’ does
not have global transferability in terms of its negative inferences. Wright
(2006) illustrates that wherever white and black communities live in close
proximity, white people always have the superior or dominant position.
Though new regimes in South Africa or Zimbabwe may appear to counter

this assertion, proportionally more white people per head of population still
retain privilege and wealth and though in the minority, still attract defer-
ence from many black citizens.
The term ‘minority ethnic groups’ does not describe a homogenous col-
lective (Sewell 2004). A Japanese woman and a West African man are so
ethnically different that it is not possible to develop a service response sup-
posedly tailored to universally meet the needs of people from BME groups.
Modood et al. 1998 takes this a step further by showing in detail the
variations in socio-economic experience and outcome of different minority
groups in Britain. The study shows the differences in the disparities across
ethnic groups in relation to such matters as housing, employment and edu-
cation. Effective practitioners in mental health will need to inform their
assessment and practice with detailed information from the service user
point of view. Service users hold the key as to the factors that they see as
relevant in their own identity. Beyond this ability to explore identity and
cultural issues from a service user perspective, a practitioner will need to
understand empirical information. Much information is available about the
impact of ethnicity on the experience of living in Britain and specifically
about interactions with mental health services. Chapter 2 highlights the
hard evidence for considering ERC as distinct issues in mental health.
It is clear that the term ‘minority ethnic group’ is useful only in signify-
ing that there is likely to be some form of differential experience and
outcome and that this needs to be explored. All assessments are in fact
strengthened by detailed consideration of identity and an understanding of
the empirical information relating to a person’s ethnic group.
18 / WORKING WITH ETHNICITY, RACE AND CULTURE IN MENTAL HEALTH
Like ethnicity, culture is considered to be changeable. Culture is described as
the substance of cohesion between people. It represents shared ideas,
non-material structures, habits and rules that help to circumscribe member-
ship of a group (Bhui 2002; Fernando 1991). Culture, simply put, means

way of life (Fernando 1995). Fernando (1991, p.10) states that ‘partly
because of its lack of precision culture is often confused with race’. Bhui
(2002, p.16) states, ‘most modern societies are mixtures of many
sub-cultures’.
Culture will shift and change as groups interact with each other. Tech-
nology alters human behaviour and migration influences everyday living.
As Fernando (1995, p.5) states, ‘cultures are not static, especially in a com-
munity where there are people from several cultures living side by side’.
Practitioners in mental health will find that they are accused of being
reductionist or stereotypical if they seek to define cultures as if they are
fixed and suited to cataloguing. A statement in absolute terms about what
any group of people is like is prone to overlook individuals. As a predictor of
personal preferences, cultural knowledge is likely to be fundamentally
flawed and is the antithesis of person-centred care. It is often advantageous,
however, to have cultural knowledge as an indicator of what might be
relevant. Cultural knowledge may enable useful questions to be asked
and will on occasions prevent offence or embarrassment being caused
unwittingly.
One problem with seeking to learn about an unfamiliar culture in
any way other than experiencing it is that the passing on of information
requires a deconstruction of complex and intricate generalisations.
Defining statements about a specific culture can only be accurate if they
include moderators such as ‘it is common ’, ‘usuall y’ or ‘often’. At best,
stereotypes or individualised perceptions are presented as norms and at
worst the person relaying the information may use it as a means of pro-
moting what they feel should be the cultural norm.
There are so many influences on culture that it is a challenge for anyone
outside of the culture to understand the norm based on Limited Acquired
Cultural Knowledge (LACK) (Se well 2004). Responding to cultural needs
therefore becomes fraught with problems from a practitioner point of view.

Not only is culture a nebulous concept; it is also barely reliably (or univer-
sally) defined by those within it.
WHAT IS ‘ETHNICITY, RACE AND CULTURE’? / 19
Culture is perceived as being less emotive than race. Fernando (1991)
and Cashmore and Troyna (1990) make the point eff ectively in reference to
the speech by the Prime Minster Margaret Thatcher in 1982 in which she
refers to Britain being swamped by other cultures. Had the Prime Minister
stated that Britons were concerned about being swamped by other races the
intensity of the reaction would have been greater; not because the sentiment
would have had no currency in 1980s Britain but because the mention of
race makes a claim of racism less easy to avoid. Culture was used euphemisti-
cally for race, a position adopted by many interested in race politics in
Britain at the time. Whatever the truth about inferences it is well recognised
that culture evokes a less passionate debate than race.
Patricia Williams, in the Reith Lectures of 1997 articulates the potency
of race well. The Reith Lectures are a series on BBC Radio 4 named after the
first director general of the corporation. These enable prominent academics
and leaders to lecture on their specialist subjects, enabling a wide audience
to have access to a high degree of expertise and specialist knowledge.
Conversations about race so quickly devolve into anxious bouts of won-
dering why we are not talking about something – anything – else, like hard
work or personal responsibility or birth order or class or God or the good
old glories of the human spirit. All these are worthy topics of conversation,
surely, but can we consider for just one moment, race (Williams 1997, p.61)
In mental health services there are times when it is right to focus on culture
and it does not just serve the function of avoiding race. There are broad
cultural differences between social groups and these do have an impact on
relationships and the perception of a shared identity. Differences in culture,
whatever is included as descriptors, may lead to real differences in under-
standings and communication of certain experiences. This has been well

argued in literature since the seminal works of Littlewood and Lipsedge
1989; Rack 1982 and Fernando 1991. It is important to remember that
there are some people within a BME group who may adhere to practices
that are codified as being ‘cultural’ and others who act or behave much less
in accordance with these codes. For practitioners there is a risk that their
understanding of a group’s culture is defined by the practices of the strict,
devout or traditional minority within it.
Practitioners are therefore faced with a challenge. Of the terms
described in this chapter, culture is discussed and explored in society and in
health and social care with the least emotion. Culture is often used euphe-
mistically for race but is weak in terms of its specificity. The avoidance of
focusing on race or minority ethnic groups takes attention off people and
deals with culture, which is nebulous and intangible.
20 / WORKING WITH ETHNICITY, RACE AND CULTURE IN MENTAL HEALTH
A major Department of Health programme to work towards equality has the
main title Delivering Race Equality (DRE) and this has been resourced and
supported at very senior levels. DRE includes a number of elements, with
training for staff being key amongst these (Department of Health 2005b).
The premise behind the element on training is that staff sometimes treat
people differently because of their race and that this has an adverse effect on
outcomes. There continues therefore to be a breakdown in logic. A major
programme of change is tackling inequality between races and there is an
acceptance that behaviour of staff in mental health services may contribute
to this but the subject of racism is avoided and its effect is even denied (e.g.
in Singh and Burns 2006).
One powerful impact of focusing on ethnicity and culture is that it neu-
tralises the language of discrimination. Terms for systematic and embedded
forms of discrimination often have an adjective/noun that is derived from
the infinitive or another root word. These derivatives cut through dialogue
and provide a description of a person or behaviour in absolute terms.

Someone is either racist or not. Frantz Fanon points to this absolute position
in Black Skin, White Masks (Fanon 1967). All such descriptions of people or
WHAT IS ‘ETHNICITY, RACE AND CULTURE’? / 21
Box 1.2 Exercise
Imagine you are an unseen observer in a training course in a
country with a cultural heritage very different to your own. In this
course a lecturer attempts to describe to the locals how people
from your country or continent behave. In their description they
refer to:
·
eating patterns
·
preferred diet
·
typical social life
·
major cultural preoccupations (e.g. typical conversations
amongst acquaintances)
·
specific tell-tale mannerisms or behaviours that distinguish
your cultural group.
First, note down what you feel you might hear the lecturer say.
Second, note down on a scale of 1 to 5 the closeness of the
descriptions to your own behaviour or experience with 1 repre-
senting the closest match and 5 the furthest.
behaviour convey a statement of abhorrence. This may not always be
helpful as it may mitigate against open discussion and exploration of
personal prejudices. A benefit however is that the accurate use of terms is
significant in problem-solving. A poorly defined problem leads to a poor
solution.

The disruption of the ability to express discrimination precisely is illus-
trated in Table 1.2.
Table 1.2 Language of discrimination
Infinitive/Root Adjective/Noun
Race Racism/Racist
Sex (Gender) Sexism/Sexist
Age Ageism/Ageist
Sexuality Homophobia/Homophobic
Nations Xenophobia/Xenophobic
Disability ‘Disablist’ is a new term emerging
Ethnicity There is no specific or absolute term.
People are described as discriminatory
on the basis of ethnicity – or racist
Culture There is no specific term
Through the use of precise terms practitioners are afforded the opportunity
to challenge themselves or to be challenged on specific agendas such as
racism. Within the context of current health and social care parlance this
opportunity is lost. As stated previously, f ailure to define the problem accu-
rately leads to poor problem-solving.
Emphasis is given to race and racism in this chapter because the patterns that
affect people of African and African Caribbean heritage have a consistent
impact that is regardless of massive variations in the culture, ethnicity or
language of people so described. The greatest degree of disparity in service
utilisation relates to this group. It is hard to see how race is overtaken by eth-
nicity or culture when the one consistent aspect in this disparate group is
race.
The language of racism becomes confused because there is still a per-
ception that racism is best understood as an act or behaviour perpetrated
by an individual. Further, it is regarded as a conscious attempt to be discrim-
22 / WORKING WITH ETHNICITY, RACE AND CULTURE IN MENTAL HEALTH

inatory. Definitions of institutional racism illustrate that this type of
discrimination comes in different forms (Carmichael and Hamilton 1967;
Cashmore and Troyna 1990; MacPherson 1999). The black activist
Stokely Carmichael coined the term ‘institutional racism’ in the 1960s
(Carmichael and Hamilton 1967). As Tuitt (2004, p.45) points out, ‘the
term institutional racism is not new to the British lexicon, but is a term that
has positively rolled off the tongue of officials, politicians and community
activists since the racist murder of Ste phen Lawrence’.
MacPherson and his colleagues defined intuitional racism in the
Stephen Lawrence Inquiry report as follows:
Institutional Racism consists of the collective failure of an organisation to
provide an appropriate and professional service to people because of their
colour, culture or ethnic origin. It can be seen or detected in processes, atti-
tudes and behaviour that amount to discrimination through unwitting
prejudice, ignorance, thoughtlessness and racist stereotyping which disad-
vantage minority ethnic people. (MacPherson 1999, p.28)
The Macpherson definition contains 55 words and this is beyond the
natural recall for a lot of people. It can be simplified by focusing on the three
key elements that underpin the MacPherson definition of institutional
racism, i.e. that there are:
·
collective failures
·
unwitting attitudes and behaviours
·
poorer outcomes for BME groups.
WHAT IS ‘ETHNICITY, RACE AND CULTURE’? / 23
Poorer
outcomes
Unwitting

behaviours
Collective
failures